HIE is critical public utility in Sandy disaster

The Statewide Health Information Network of New York (SHIN-NY) sees itself as a "public utility" as much as an HIE. In the wake of Hurricane Sandy, as patients bounce between hospitals (and as other public utilities, such as electricity and transportation, are compromised), it has enabled critical continuity of care.

The images of dozens of red-flashing ambulances, evacuating as many as 200 patients – some of them in critical condition, some of them infants – from NYU Langone Medical Center, whose backup generator had failed, to hospitals such as Sloan-Kettering and NewYork-Presbyterian, will be some of the most enduring images from the super storm.

The harrowing process was made much smoother by the fact that those patients' electronic health records were secure and readily accessible at the hospitals to which they were transported, thanks to New York's statewide HIE.

Healthcare IT News spoke with David Whitlinger, executive director of New York eHealth Collaborative (NYeC), which oversees SHIN-NY, about what's happening in New York City, about the critical roles for health information exchange in crisis situations, and about his hopes that this can be a teachable moment for those care providers that have yet to link up with an HIE.

Describe what's happening in New York City right now.

All the services – electricity, Internet – all those things are really struggling right now in Manhattan and in some surrounding counties. Everybody's trying to make do, from a living perspective.

All the healthcare services have backup generators and backup systems, so they're not in duress. But the communities at large are just trying to learn how to live without at this point.
It's looking like some of the power outages might last a week or more in the outer counties, and then in the upstate region we're supposed to get several feet of snow, and so forth. So that'll be another wave of natural effects that could have impact.

For the most part, the data centers and all of our connectivity weathered through the storm well. It's a matter of people utilizing the services – where they might not have had access to information, they now do, as long as they can get an Internet connection.

What is NYeC doing to respond? Are you doing outreach to hospitals?

The hospitals that are receiving patients now, from some of the other hospitals that are having to move patients around, they have continuity because they are able to access the records through the HIE.

We're not having to do anything boots-on-the-street explicit. That's the power of the virtual network. For the most part this just happens naturally. It happens as part of the course of the network that's in place.

Are all the hospitals in the city that were adversely affected by the storm taking part in SHIN-NY?

I couldn't say. I don't know all the hospitals. I'd have to cross-check a reference to see if that was the case. I know several of them were, but I don't know if I could say definitively that all were on the network.

Describe the process, once a patient is evacuated to another hospital across town. Is it as simple as calling up their EHR in the new location?

That's absolutely right. At the hospital that received the patient, they use the clinical viewer. They log in securely, they do a patient record lookup, given the demographics of the patient that's before them, that they're admitting, and then they can see the records from the previous hospital.

New York is in a good position, as one of the most populous cities in the world. It's going to be more connected than in more far-flung, rural areas.

The greatest thing I can say in that regard is in comparison, you look back to Katrina – obviously a different city, but still, New Orleans is a sizable city, it's not a tiny city. And that era of Katrina, a lot of the healthcare system in that region was on paper records. And, literally thousands and thousands – millions – of records were physically lost – irretrievably damaged, and never to be replaced.

In the aftermath of Katrina, patients are going to their physicians not knowing what medications they were on, and not knowing what their steady state vital signs were. It's just not something patients carry with them. It's all recorded on paper record. A lot of patients had to start from scratch when they started interacting with the healthcare system on the other side of the disaster.

Here we are a few years later, in New York, having invested several hundred million dollars in a HIE network, and we have much, much greater continuity of care, and much greater continuity of electronic health records. At a minimum, a majority of all healthcare institutions have electronic health records, and the backups of those records are not even in the city, they're elsewhere across the country.

So even if the healthcare provider is not connected to the network, at a minimum, the patient's data is not lost. It's not paper. It's somewhere else. It's bits, and these bits are backed up in other parts of the country, so that in times of disaster they're always available.
The greater effect is that today a lot of these systems are on a network, the State Health Information Network, whereby the records are immediately available, without any complex procedures, to the healthcare providers that are working the scene.

How have the power outages, many of which could last for several days, even longer, affected the hospitals and the HIE?

Almost all of the hospitals do have continuous power, either via diesel generators or other backup systems. And they always have their data centers on that backup power. But a lot of healthcare institutions today don't even have a data center. It's hosted remotely by their EHR vendor or a remote hosting facility. Those hosting entities, that's their bread and butter: always to be up, never to take a loss from a power outage. That's the point of them being in existence.

So then it's just a matter of whether the healthcare institution itself has computers, terminal such that you can have access, and is their network communication working such that they can get to their data center. That's much, much easier to facilitate. You can even do it with a cellular-enabled tablet, like an iPad.

When a hospital is running on backup power during an emergency, can they run all the clinical IT they ordinarily would, or do they need to triage, and only run mission-critical technology?

It depends on the size of the organization. Yes, some of them do have to triage what they have on continuous power and what they have to sacrifice during times of outage. But also, do remember that ConEdison itself prioritizes those institutions for getting back up if they do go down, and they are on redundant power systems just from ConEdison itself. So the impact is less than for the general consumer.

Do you see a natural disaster such as this as an object lesson – a selling point – on the value of health information exchange?

Absolutely. We've already seen that from the hospitals that are participating. They've already said, "Hey, we didn't take an outage, but we kind of realize now that our records are in your network as well, and if we had a problem, we could have fallen back on the state network systems. That's a big boon for us, let's think about that."

Perhaps in their thinking they're communicating that "We're not there yet, but we need to think about having as much redundancy as we need to have if you're our safety net. If you're investing in an always-up network, do we need to have our own very robust disaster recovery, maybe you're part of our plan instead."

So we're starting to have those conversations, which I think is a very good state to be in. If everybody has to spend enormous financial resources on disaster recovery on their own, where they could rely on a state public utility resource for that, there could be some substantial savings.

What's on NYeC's to-do list in the coming days?
We're going to be going through all our processes and procedures, just making sure that we have everything up to snuff. There were places where we could have done a little bit better, where our people got stuck at home and didn't have Internet access, and we could have had them have cellular capabilities, and they could have had a little bit easier time of things.

New York City emergency teams did contemplate this last week: What could the state network do for them in the time of crisis. And one of the interesting use cases that came about was something along the lines of: If we had a large number of people that had to get admitted to hospitals randomly across the city because of a significant disaster, how would we know who got admitted where, and how would we let loved ones know how to find their family members.

In the pre-9/11 days, that meant some family member or some government official, such as a police officer, doing a missing persons search: calling every hospital in this city and asking if they knew where this person was.

But with the state network, we get an electronic message from the electronic health record systems of every hospital when they admit someone. So we could very quickly tell, if somebody is looking for somebody, where they were admitted. And it doesn't cost any kind of human resources to make those searches, inquiries and responses. It could be very easily applied to those emergency disaster scenarios.

What are some lasting lessons that can be drawn from this crisis?

At this stage, we really believe, and New York has made the investment such that we can really look forward to this: This health information exchange network really can and should be seen as a public utility, for the public good.

And this is another example of how it can be as critical as having roads, as having fire hydrants, as having an electricity backbone.

This has got the same value to a community. Both in the form of providing better transactions and a better form of care in non-emergency times, but also when the community gets stressed like this, during a natural disaster, it only elevates the importance and value of having this as a public utility. It's not a commercial enterprise, it's here for the public good, and this is an example.